Dear
Rod:
After nearly three decades as a member it is with a mixture of
pleasure and disappointment that I submit this letter of resignation
from the American Psychiatric Association. The major reason for
this action is my belief that I am actually resigning from the
American Psychopharmacological Association. Luckily, the organization's
true identity requires no change in the acronym.

APA
reflects, and reinforces, in word and deed, our drug dependent
society. Yet, it helps wage war on "drugs". "Dual
Diagnosis" clients are a major problem for the field but
not because of the "good" drugs we prescribe. "Bad"
ones are those that are obtained mostly without a prescription.
A Marxist would observe that being a good capitalist organization,
APA likes only those drugs from which it can derive a profit--directly
or indirectly. This is not a group for me. At this point in history,
in my view, psychiatry has been almost completely bought out by
the drug companies. The APA could not continue without the pharmaceutical
company support of meetings, symposia, workshops, journal advertising,
grand rounds luncheons, unrestricted educational grants etc. etc.
Psychiatrists have become the minions of drug company promotions.
APA, of course, maintains that its independence and autonomy are
not compromised in this enmeshed situation. Anyone with the least
bit of common sense attending the annual meeting would observe
how the drug company exhibits and industry sponsored symposia
draw crowds with their various enticements while the serious scientific
sessions are barely attended. Psychiatric training reflects their
influence as well; i.e., the most important part of a resident
curriculum is the art and quasi-science of dealing drugs, i.e.,
prescription writing.

These
psychopharmacological limitations on our abilities to be complete
physicians also limit our intellectual horizons. No longer do
we seek to understand whole persons in their social contexts,
rather we are there to realign our patients' neurotransmitters.
The problem is that it is very difficult to have a relationship
with a neurotransmitter, whatever its configuration. So, our guild
organization provides a rationale, by its neurobiological tunnel
vision, for keeping our distance from the molecule conglomerates
we have come to define as patients. We condone and promote the
widespread overuse and misuse of toxic chemicals that we know
have serious long term effects: tardive dyskinesia, tardive dementia
and serious withdrawal syndromes. So, do I want to be a drug company
patsy who treats molecules with their formulary? No, thank you
very much. It saddens me that after 35 years as a psychiatrist
I look forward to being dissociated from such an organization.
In no way does it represent my interests. It is not within my
capacities to buy into the current biomedical-reductionistic model
heralded by the psychiatric leadership as once again marrying
us to somatic medicine. This is a matter of fashion, politics
and, like the pharmaceutical house connection, money.

In
addition, APA has entered into an unholy alliance with NAMI (I
don't remember the members being asked if they supported such
an organization) such that the two organizations have adopted
similar public belief systems about the nature of madness. While
professing itself the champion of their clients the APA is supporting
non-clients, the parents, in their wishes to be in control, via
legally enforced dependency, of their mad/bad offspring. NAMI,
with tacit APA approval, has set out a pro-neuroleptic drug and
easy commitment-institutionalization agenda that violates the
civil rights of their offspring. For the most part we stand by
and allow this fascistic agenda to move forward. Their psychiatric
god, Dr. E. Fuller Torrey, is allowed to diagnose and recommend
treatment to those in the NAMI organization with whom he disagrees.
Clearly, a violation of medical ethics. Does APA protest? Of course
not, because he is speaking what APA agrees with but can't explicitly
espouse. He is allowed to be a foil; after all he is no longer
a member of APA. (Slick work APA!) The shortsightedness of this
marriage of convenience between APA, NAMI and the drug companies
(who gleefully support both groups because of their shared pro-drug
stance) is an abomination. I want no part of a psychiatry of oppression
and social control.

Biologically
based brain diseases are convenient for families and practitioners
alike. It is no fault insurance against personal responsibility.
We are just helplessly caught up in a swirl of brain pathology
for which no one, except DNA, is responsible. Now, to begin with,
anything that has an anatomically defined specific brain pathology
becomes the province of neurology (syphilis is an excellent example).
So, to be consistent with this brain disease view all the major
psychiatric disorders would become the territory of our neurologic
colleagues. Without having surveyed them I believe they would
eschew responsibility for these problematic individuals. However,
consistency would demand our giving over biologic brain diseases
to them. The fact that there is no evidence confirming the brain
disease attribution is, at this point, irrelevant. What we are
dealing with here is fashion, politics and money. This level of
intellectual/scientific dishonesty is just too egregious for me
to continue to support by my membership.

I
view with no surprise that psychiatric training is being systemically
disavowed by American medical school graduates. This must give
us cause for concern about the state of today's psychiatry. It
must mean at least in part that they view psychiatry as being
very limited and unchallenging. To me it seems clear that we are
headed toward a situation in which, except for academics, most
psychiatric practitioners will have no real relationships--so
vital to the healing process--with the disturbed and disturbing
persons they treat. Their sole role will be that of prescription
writers: ciphers in the guise of being "helpers".

Finally,
why must the APA pretend to know more than it does? DSM-IV is
the fabrication upon which psychiatry seeks acceptance by medicine
in general. Insiders know it is more a political than scientific
document. To its credit it says so--although its brief apologia
is rarely noted. DSM-IV has become a bible and a money making
best seller--its major failings notwithstanding. It confines and
defines practice, some take it seriously, others more realistically.
It is the way to get paid. Diagnostic reliability is easy to attain
for research projects. The issue is what do the categories tell
us? Do they in fact accurately represent the person with a problem?
They don't, and can't, because there are no external validating
criteria for psychiatric diagnoses. There is neither a blood test
nor specific anatomic lesions for any major psychiatric disorder.
So, where are we? APA as an organization has implicitly (sometimes
explicitly as well) bought into a theoretical hoax. Is psychiatry
a hoax--as practiced today? Unfortunately, the answer is mostly
yes.

What
do I recommend to the organization upon leaving after experiencing
three decades of its history?

To
begin with, let us be ourselves. Stop taking on unholy alliances
without the members permission.

Get
real about science, politics and money. Label each for what
it is-that is, be honest.

Get
out of bed with NAMI and the drug companies. APA should align
itself, if one believes its rhetoric, with the true consumer
groups, i. e., the ex-patients, psychiatric survivors etc.

Talk
to the membership. I can't be alone in my views.

We
seem to have forgotten a basic principle: the need to be patient/client/consumer
satisfaction oriented. I always remember Manfred Bleuler's wisdom:
"Loren, you must never forget that you are your patient's
employee. In the end they will determine whether or not psychiatry
survives in the service marketplace."